Spontaneous intra-adrenal massive hematoma: possible extreme evolution of a non-secreting untreated adrenal adenoma

The spontaneous adrenal hematoma is a rare event. An 83-year-old male patient presented a 26-cm asymptomatic retroperitoneal mass of doubtful renal–adrenal origin. He had been evaluated 10 years before for an adrenal incidentaloma of 2.3 cm and had refused surgery when it had reached 7 cm. Later, the mass enlarged to 26 cm and was surgically removed through an open anterior approach. The histopathology showed a solid 4 kg mass of fibrinoid–hemorrhagic material, partially necrotic, mixed with adrenal tissue, with a well-vascularized capsule. No relapse is present at 6-month follow-up. This is the largest case described of spontaneous intra-adrenal hematoma in a case with previous non-secreting adrenal adenoma. The hematoma (a 4 kg mass) developed 10 years after the first diagnosis and exposed the patient to potential damage of the surrounding organs and to high-risk abdominal surgery. Long-term follow-up of non-secreting adrenal adenomas should be recommended.

Association Between Adrenal Hematoma and Mortality in Pediatric Multiple Blunt Traumas: An Autopsy Evaluation

<p>Adrenal hematoma is a common hidden catastrophic complication in pediatric victims of multiple blunt traumas. Adrenal hematoma has no obvious symptoms and may not be detected by diagnostic methods such as magnetic resonance imaging, computed tomography scan, and sonography; consequently, this complication may be neglected in children with multiple blunt traumas and cause death through sudden adrenal crisis.</p><p>The current study was conducted on 55 dead children (&lt;13 y) and 110 matured youths (13–17 y) who died in consequence of multiple blunt traumas, comprising car crashes, fall from heights, and falling debris. Our autopsy results showed that the overall prevalence of adrenal hematoma was 26% and this rate was higher in lower ages (1–6 y). There was no significant difference regarding the occurrence of adrenal hematoma between the genders. Adrenal hematoma was most common in abdominal and pelvic traumas. Peritoneal hemorrhage, liver damage, spleen rupture, omental injury, retroperitoneal hemorrhage, renal hematoma, and pelvic fracture were the most common complications associated with adrenal hematoma. In contrast to the previous studies, hematoma was mostly observed in the left adrenal. The incidence of damage to the pancreas, which similarly to the adrenal is a retroperitoneal organ, was very low (1.7%).</p><p>The high incidence of adrenal hematoma due to severe abdominopelvic trauma in children warrants further research. Future studies should shed sufficient light on the efficacy of prophylactic steroids in patients with suspicion of severe abdominopelvic trauma.</p>